Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico por imagem , Hipotálamo/diagnóstico por imagem , Oftalmoplegia/diagnóstico por imagem , Oftalmoplegia/etiologia , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico por imagem , Adulto , COVID-19 , Feminino , Humanos , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2RESUMO
Interruption of the inferior vena cava (IVC) with azygos continuation is a rare congenital anomaly, in which the IVC is interrupted below the hepatic vein and venous return beyond this point is restored by the dilated azygos and hemiazygos veins draining into the superior vena cava. A case of the interruption of the IVC with azygos/emyazygos continuation for the absence of the hepatic segment of IVC, left renal vein duplication, and polysplenia is reported. The embryologic, clinical, and radiological significance are discussed. The diagnosis is suggested by X-ray, but contrast-enhanced multidetector computed tomography is the method of choice to diagnose this venous anomaly and reveals the aberrant vascular structures. Awareness of different congenital anomalies of IVC is important to surgeons and cardiologists and is necessary for radiologists to avoid diagnostic pitfalls and for preoperative planning: they should be remembered because they can influence several surgical interventions and endovascular procedures. Accidental ligation of the azygos vein is fatal and cardiac catheterization using the lower extremity vein is troublesome in patients with this condition.
RESUMO
INTRODUCTION: The purpose of this study is to report on a multi-center experience of ruptured intracranial aneurysms treated in acute phase with stent-assisted coil embolization, including primary success rates and midterm follow-up results. MATERIALS AND METHODS: Retrospective analysis was performed on a sample of 40 patients (14 men, 26 women, mean age 59.7 years) affected by ruptured saccular aneurysms and treated by stent-assisted coiling in acute phase; double antiplatelet therapy with clopidogrel bisulphate and acetylsalicylic acid was started after the procedure. Angiographic follow-up at 1 year was recorded. RESULTS: 20 % of the aneurysms were located in the posterior circulation, and 85 % presented a wide neck. Mean size of the sac was 7 mm (range 3-22 mm). Complete sac exclusion was obtained in 92.5 % and neck remnant in 7.5 %. The overall complications rate was 15 %. In 7.5 %, stent occlusion occurred intra-procedurally. In 12.5 %, re-bleeding was detected within 3 weeks after the procedure. Ischemic area related to the procedure was observed at follow-up in 7.5 %. Hydrocephalus developed in 15 %. 7.5 % presented with sac re-bleeding between 1 and 5 months after the procedure. In 15 %, the 3-6 months of follow-up revealed aneurysm refilling. 25 % of the patients presented vessel stenosis at the 1-year DSA of control. 33 % of the patients reported sensory-motor deficits. 82.5 % had a favorable outcome (GOS: IV-V), while 17.5 % presented a poor score (GOS: I-III). CONCLUSIONS: Stent-assisted coil embolization is a feasible endovascular treatment option for ruptured intracranial aneurysms, which is difficult to approach with simple coiling; however, neurointerventionalists need to consider a mild increase of post-procedural complications rate.
Assuntos
Aneurisma Roto/terapia , Embolização Terapêutica/métodos , Aneurisma Intracraniano/terapia , Stents , Doença Aguda , Aneurisma Roto/diagnóstico por imagem , Aspirina/uso terapêutico , Clopidogrel , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Neuroimagem , Inibidores da Agregação Plaquetária/uso terapêutico , Radiografia Intervencionista , Estudos Retrospectivos , Ticlopidina/análogos & derivados , Ticlopidina/uso terapêutico , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
This study assessed the one-year clinical and radiographic outcomes, in terms of pain-relief, vertebral re-fracture and complications, after vertebroplasty (VP) using a new osteoconductive cement (calcium triglyceride bone cement - Kryptonite™ bone cement, Doctors Research Group Inc., Southbury, CT, USA) to treat osteoporotic vertebral compression fractures. Sixteen consecutive osteoporotic patients (12 women and four men, mean age 68+/-10.5) were treated with VP using Kryptonite™ bone cement for a total of 20 vertebral fractures. All the patients complained of a pain syndrome resistant to medical therapy and all procedures were performed under fluoroscopy control with neuroleptoanalgesia using a monopedicular approach in 12 patients and bipedicular approach in four patients. All patients were studied by MR and MDCT and were evaluated with the visual analogue scale (VAS) and the Oswestry disability index (ODI) before treatment and at one and 12 months after the procedure. A successful outcome was observed in 80% of patients, with a complete resolution of pain. Differences in pre and post treatment VAS and ODI at one-year follow-up were significant (P<0.0001). We observed a disk and venous leakage in 66% of patients but only in one case did an asymptomatic pulmonary embolism occur during cement injection. Two cases of vertebral re-fractures at distant metamers were observed during follow-up. VP using Kryptonite bone cement is a helpful procedure that allows complete and long-lasting resolution of painful vertebral symptoms. The cost of the material is very high and the rate of disk and venous leakage is too high compared to standard cement.
Assuntos
Cimentos Ósseos , Óleo de Rícino , Polímeros , Compressão da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/métodos , Idoso , Idoso de 80 Anos ou mais , Óleo de Rícino/efeitos adversos , Óleo de Rícino/economia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/cirurgia , Dor/etiologia , Dor/cirurgia , Medição da Dor , Polímeros/efeitos adversos , Polímeros/economia , Complicações Pós-Operatórias/epidemiologia , Compressão da Medula Espinal/etiologia , Fraturas da Coluna Vertebral/complicações , Resultado do TratamentoRESUMO
Ependymoma has been described typically as an intramedullary tumour derived from ependymal cells with a predominance in women in the fifth decade of life. Pain is the most frequent symptom. Intradural extramedullary presentation is rarely described and almost always as a unique lesion. We describe a 53-year-old man with multi-segmental diffuse intradural extramedullary ependymoma with progressive lower leg hypoesthesia with regular motility. The patient's neurologic condition improved after surgery.
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Ependimoma/patologia , Imageamento por Ressonância Magnética , Neoplasias da Medula Espinal/patologia , Medula Espinal/patologia , Descompressão Cirúrgica , Ependimoma/complicações , Ependimoma/cirurgia , Humanos , Hipestesia/etiologia , Hipestesia/cirurgia , Masculino , Pessoa de Meia-Idade , Medula Espinal/cirurgia , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/cirurgiaRESUMO
Chordoma is a rare malignant tumor of the bone; it arises from embryonic remnants of the primitive notochord and occurs along the midline from the skull base to the sacrum. In this article, we reviewed the origin, location, clinical, histopatological and imaging features, treatment, and differential diagnosis of chordoma.